Sex offenders, sentencing laws and pharmaceutical treatment: a prescription for failure

The phenomenon of adults who have sexual interests involving children as partners, or pedophiles, is considered among the most sociopathological of human conditions. Considerable literature is devoted to issues and problems associated with or related to pedophilia, including prevalence, etiology, treatment, and outcome studies. The sexual victimization of children, based upon data gathered from a number of sources, suggests an intractable problem that is national in scope. Recent manifestations of society's efforts to deal with the sexual victimization of children include the enactment of criminal sentencing laws that mandate the treatment of offenders with certain pharmaceutical agents, such as medroxy-progesterone acetate ("MPA"). Because sentencing laws as a rule vary widely from state to state, there is considerable variation as to who is subject to MPA treatment laws, and how such laws-including specific provisions, such as clinical criteria, if any, required for treatment; type and period of treatment plans; informed consent; etc-are implemented. Most important, these sentencing laws may have remarkably little relation to what is widely considered effective treatment for pedophilia disorders. We examine in detail the most recent sentencing laws pertaining to treatment of persons who have been convicted of sex offenses involving children as victims. Our critique may offer insight and suggestions as to how such sentencing laws can be more suitably tailored to the treatment needs of persons with pedophilia disorders.     

Sexual predator commitment laws: lessons for law and the behavioral sciences

Sex offender commitment laws use a mental health commitment model to lock up the "most dangerous" sex offenders after their prison sentences expire. In Kansas v. Hendricks, the United States Supreme Court rejected the major constitutional challenges to these laws. The Hendricks case clarifies important ambiguities about the use of civil commitment to enforce "police power" interests, as opposed to "parens patriae" interests. Hendricks also clarifies the role of "treatment" in justifying civil commitment. While there remain some important legal issues to be resolved, the future direction of sex offender commitment schemes will turn most significantly on policy decisions. The behavioral sciences can play an important role in shaping these decisions. The most significant questions concern whether expensive commitment programs are the most effective use of scarce treatment and supervision dollars. Additional research should be directed to improving dynamic predictors of recidivism, operationalizing "inability to control" standards, judging the "social meaning" of commitment laws, and assessing the potential treatment disincentives of these laws.     

Sexuality in youth culture: identity and change.

The sexual decisions of adolescents are, as Brooks-Gunn and Furstenberg have suggested, filtered through at least three culturally determined screens: the meaning of sexuality, the process of male-female negotiations, and adolescents' perception of danger. In making sexual choices today, young people must consider not only issues of identity, personal growth, and relationships, but also the growing danger of AIDS. A ten-year study of the sexual behavior of college students in Kelowna, British Columbia, Canada, shows that students choose among three sexual subcultures: celibacy, monogamy, and free experimentation. Since 1980, there has been some shift away from casual sex toward committed partnerships, but the basic outlines of this sexual "plural society" have remained unchanged. Despite AIDS, most students have not adopted careful sexual practices, either in number of partners or use of condoms. North American data suggest that this pattern is typical of most colleges and universities throughout Canada, although students on many U.S. campuses have become more careful. This study explored the reasons behind sexual choices, and investigated whether the possibility of contracting AIDS will eventually lead adolescents to better balance their needs for sex, love, freedom, and self-preservation. Working against the choice of caution is the fact that, in our culture, sexual expression is an important element of becoming an adult.     

Issues in the psychopharmacologic assessment and treatment of the orthodox Jewish patient

As with members of other cultural and religious groups, patients within the Orthodox Jewish community present with their own distinct clinical psychiatric issues related to their unique beliefs and practices. This article reviews the existing literature and anecdotal experience on the psychopharmacologic assessment and treatment of Orthodox Jewish patients. Specific aspects examined include this group's perceived intense stigma in receiving treatment, the priority this community places on cognitive functioning, and how the influence of Jewish laws on marriage and sexual practices impacts one's treatment decisions. The relevance of Jewish dietary laws, the Sabbath, and the community's interest in alternative treatments are also discussed. The limited ethno-psychopharmacology research related to Orthodox Jewish psychiatric patients is reviewed. We conclude that understanding issues such as these is critical if one is going to work within this cultural system in order to successfully address their mental health issues. However, the dearth of controlled research in this community needs to be addressed to provide more effective treatment.     

Disclosure of HIV Status Among Female Youth With HIV

Minority female youth are significantly affected by the HIV epidemic. The purpose of this pilot study was to explore sexual behavior practices, disclosure of HIV status, attitudes about disclosure, and knowledge of HIV disclosure laws among female youth with HIV (YWH). Findings suggest that the majority of YWH studied have been sexually active since their HIV diagnosis, although the nature and extent of sexual activity varied. Rates of nondisclosure to sexual partners varied based on the type of question asked, but at least some of the YWH in this sample reported sexual activity with a partner who was unaware of the participant’s HIV status. YWH appear to be more likely to disclose before, as opposed to after, sexual activity. Although most YWH believe disclosure to sexual partners is important for a variety of reasons, many reasons exist for nondisclosure, including fear of rejection and limited communication skills. The majority of YWH in this sample were aware of the potential legal ramifications of nondisclosure although fear of legal repercussions was not the most important factor related to disclosure. These findings favor the implementation of HIV disclosure interventions over the enactment of HIV criminalization laws as a strategy for reducing HIV transmission.     

Adolescent sexuality in a therapeutic community: staff countertransference issues

Issues connected with sexuality such as heterosexual relationships, homosexuality, sexual identity, and seductiveness, create conflict and countertransference dilemmas for staff who work with psychiatric patients in a therapeutic community. When the therapeutic community is composed of adolescents, these issues are exacerbated since sexual identity and sexual development are major concerns. The staff reacts strongly to the issue of self-determination and violation/infringement on a basic human need. These philosophical differences have their roots in countertransference feelings. Staff sometimes find it difficult to confront adolescents on emotionally charged issues that have a sexual coloring. A system is proposed for articulating and working through these feelings. A unique solution is posited for solving this conflictual attitude (based on object relations theory), whereby the residential treatment center serves as the analog of the home in order to allow adolescents to develop a sense of self before they can move on to the halfway house where heterosexual behavior is allowed (as part of the therapeutic process). This facilitates the meeting of the "self" with the "other." This procedure is explored in light of Sullivan's concept of intimacy.     

Legal issues in maximum security institutions for people with mental illness: liberty,security, and administrative discretion

This article explores four legal issues relevant to the provision of care in secure hospitals. These include the current status of right to treatment litigation; the potential impact of the Americans with Disabilities Act; new developments in laws governing restraint and seclusion; and the need for uniform institutional policies on risk assessment. These issues illustrate the potential conflicts between individual autonomy and institutional control that have been at the heart of mental health law for three decades. The article suggests that because of the diminishing oversight provided by the federal judiciary, institutional custodians have a particular obligation to ensure that individual rights are not overwhelmed by concerns with security.     

Buying a passport to heaven: Usury,restitution, and the merchants of medieval Genoa

Historians have argued that the ecclesiastic ban on loans at interest delayed the development of capital markets in the middle ages, and have supported this by pointing to well-documented cases of restitutions of usurious gains by famous moneylenders. Strictly, however, such evidence does not prove that usury laws affected lending, because donations by rich bankers may reflect other motivations. If usury laws had an impact, we have to exclude the Medicis or the Fuggers from the sample, and look for it among the small moneylenders of medieval Europe. Data from late medieval Genoa show that donations by merchants were no greater than those of the population at large once personal wealth is accounted for. However, among merchants the value of pious bequests correlates more closely with mercantile activity than personal wealth, a finding that supports the view that usury laws created an effective constraint on medieval capital markets.     

Reasons for Pornography Consumption: Associations with Gender,Psychological and Physical Sexual Satisfaction,and Attitudinal Impacts

The purpose of this investigation is to examine the associations among gender and reasons for pornography consumption as well as attitudinal impacts. One hundred and forty-three participants, ranging in age from 18 to 48 (M = 21.22), participated in an online study at a large, southwestern university. Seventy-six of these participants identified as current consumers of pornography and are the primary focus of the analyses. Findings indicate that regardless of gender, pornography is preferably consumed in a solitary fashion for masturbatory purposes with a perceived positive physical, but not psychological, sexual satisfying impact for the self as well as for the consuming partner. Further, regarding attitudinal impacts, current male consumers of pornography report significantly higher adversarial sexual beliefs, rape myth acceptance and sexual conservatism than do current female consumers of pornography. Discussion and future directions follow.     

Buying a passport to heaven: Usury, restitution, and the merchants of medieval Genoa

Historians have argued that the ecclesiastic ban on loans at interest delayed the development of capital markets in the middle ages, and have supported this by pointing to well-documented cases of restitutions of usurious gains by famous moneylenders. Strictly, however, such evidence does not prove that usury laws affected lending, because donations by rich bankers may reflect other motivations. If usury laws had an impact, we have to exclude the Medicis or the Fuggers from the sample, and look for it among the small moneylenders of medieval Europe. Data from late medieval Genoa show that donations by merchants were no greater than those of the population at large once personal wealth is accounted for. However, among merchants the value of pious bequests correlates more closely with mercantile activity than personal wealth, a finding that supports the view that usury laws created an effective constraint on medieval capital markets.     

Homosexuality and HIV in Africa: An Essay on Using Entertainment Education as a Vehicle for Stigma Reduction

HIV transmission in sub Saharan Africa has been consistently reported to be heterosexual. The existence of Men who have Sex with Men (MSM) has been denied and the epidemic among them ignored although homosexuality in the continent has been documented. Consequently, limited research has been conducted among Africa’s MSM. Homophobia has been reported as one of the key forces driving Africa’s epidemic because stigma and discrimination may make MSM a hard-to-reach group for HIV prevention and early treatment services. We conducted searches in journals, newspapers, UNAIDS and MSM web sites to read laws, abuse, and discrimination of MSM. We reviewed literature on entertainment education and its success in addressing social, political, and health issues worldwide in order to propose a solution to the issue. Fifty-five percent of African countries have laws against sex between men. Penalties range from fines, imprisonment, or death. Official harassments, state sponsored homophobia and threats against MSM have been documented. Stigmatization can create barriers to testing, restrict utilization of prevention programs, condom use, and failure to disclose HIV status to sexual partners. This paper suggests a communication strategy such as entertainment education to raise awareness and tolerance and to promote action in the fight against HIV/AIDS epidemic and related stigmatization among Africa’s MSM. Entertainment Education which derives from various theories can be disseminated through radio or TV and can bring behavior and social change by offering the audience an opportunity for social learning. It has been effective worldwide and examples include Grey’s Anatomy, ER, Philadelphia, Soul City, Eastenders, and the telenovela Simplemente Maria and can pave way for HIV prevention and treatment in a vulnerable population.     

Shame in Sexual Minorities: Stigma,Internal Cognitions,and Counseling Considerations

Theorists, clinicians, and researchers have suggested that shame is a central concern in the lives of sexual minority individuals. Cognitive theorists believe that shame occurs when a person fails to achieve his or her standards, which are often based on social, cultural, and spiritual values. Although it is asserted that stigma causes shame among members of a sexual minority, the empirical evidence suggests that negative internal cognitions are partly responsible. By targeting negative beliefs, counselors can help sexual minorities reduce their sense of shame, particularly around issues related to sexual identity. The authors offer counseling strategies for reducing shame in sexual minority clients.     

Sexuality education groups in juvenile detention

Several major studies have described the magnitude and character of adolescent sexual activity and sexual knowledge related to contraception and sexually transmitted diseases (Diepold & Young, 1979; Hass, 1979; Sorenson, 1973; Zelnick & Kantner, 1980). Few systematic studies have been conducted, however, which analyze the attitudes toward sexuality and contraception of delinquent adolescents who are generally school dropouts and who may engage in socially unacceptable behaviors such as running away, drug abuse, and prostitution. Delinquent youths, especially delinquent girls, have been characterized as being more sexually active and less sexually knowledgeable than their nondelinquent peers (Gibbon, 1981; Mannarino & Marsh, 1978). Despite the assumed high-risk nature of this delinquent population, few juvenile detention facilities have offered systematically evaluated coeducational sex education programs. One barrier to implementation of such programs in juvenile detention centers is the lack of a treatment or program orientation of most staff, and/or staff denial of adolescent sexuality in general, an attitude which suppresses the development of healthier sexual values and often promotes pathologic sexual interaction within institutions (Shore & Gochros, 1981). A recent survey of adolescent sexuality (Diepold, 1979) points out that teenagers' feelings about their "sexual selves" impacts greatly upon their general self-image. Low self-esteem is more frequently found among delinquents than nondelinquents (Jones & Swain, 1977; Lund & Salury, 1980), and treatment for delinquent girls often focuses on increasing self-esteem and developing assertiveness skills based on feelings of self-worth (DeLange, Lanahan, & Barton, 1981; NiCarthy, 1981). Two studies carried out with juvenile detainees from a large urban center confirmed that sexual activity among delinquent adolescents is significantly greater than that of the general adolescent population, and that the delinquents have little or no knowledge of birth control methods or venereal disease (Deisher, 1980; Schroeder, 1981). Further, these adolescents appear to endorse constricted and conventional values related to sexual activity, abortion, and relationship issues and frequently have a background of sexual abuse and prostitution. These findings form the basis of the current study which attempts to develop an effective coeducational sex education program for this population within a detention facility. This program is specifically designed for a sexually active adolescent group aged 14 to 17.     

Desire in the face of death: Terror management,attachment, and sexual motivation

Four studies examined the impact of mortality salience (MS) on sexual motivation. In Studies 1–3, participants were primed with death‐related thoughts and then rated their desire to engage in sex in different contexts. Study 4 included an assessment of reasons for engaging in sex. Results showed that MS increased the desire for romantic sex, regardless of gender, and the desire for casual sex among more avoidant men. Sexual desire was fueled by distinct patterns of motives among highly anxious and avoidant people. These findings suggest that the variety of meanings sexual behavior has for different people may explain why, in some cases, sexual behavior may function as a defense against mortality concerns, whereas in other cases, it may exacerbate threat.     

Smile when you call me that!: The problems with punishing hate motivated behavior

During the last several years, many jurisdictions have enacted laws meant to punish behavior motivated by racial hatred or other forms of bigotry. The actual impact of these laws is probably largely symbolic. These laws, which are often called “hate crime” laws, have a number of problems. Hate crime laws may violate the constitution, but this problem can usually be avoided through careful drafting. More importantly, there are a number of practical and policy problems with hate crime laws; not only are these crimes difficult to identify, but they involve the problematical consideration of the offender's motive. In addition, social scientific theories suggest that the laws may actually increase bigotry and disempower minorities. For these reasons, it is recommended that policy-makers explore other means of reducing bigotry.     

The Role of Sexual Trauma in the Treatment of Chemically Dependent Women: Addressing the Relapse Issue

A review of the literature indicates a high incidence of sexual trauma among women who seek treatment for substance abuse. Additionally, clients who have experienced sexual trauma appear to be more susceptible to relapse, the return to substance abuse. This article explores issues surrounding sexual trauma and chemical dependency. It aims to provide direction for relapse prevention with a relapse-prone population. Application of traditional milieu substance abuse treatment for sexual trauma survivors is explored. Recommendations for working with sexual trauma survivors who are also substance abusers are presented, as are suggestions for research.     

Ethical principles in the counseling of gay and lesbian adolescents: issues of autonomy, competence, and confidentiality

Ethical dilemmas in counseling gay and lesbian adolescents are analyzed according to underlying ethical principles. Developmental issues and their relevance to therapy are emphasized. Conflicts among client autonomy, claims of paternalism, and limits of confidentiality are examined. Competence to enter therapy for issues of sexual identity is assessed. The author concludes that adolescents are generally competent to explore issues of sexual identity.     

Psychosexual Dysfunction Among Gynecological Cancer Survivors

The purpose of this paper is to summarize the empirical findings related to the assessment and treatment of sexual difficulties commonly experienced by gynecological cancer survivors and to make suggestions for future research and practice in this area. First, we describe the sexual problems that are most frequently reported by gynecological cancer patients and some of their common medical and psychological correlates. These include pain, premature ovarian failure, changes in vaginal anatomy, emotional distress, body image, and sexual self-concept. The complex interaction of physiological and psychological variables plays an important role in the development of sexual dysfunction in this patient population. Furthermore, we review the empirical studies that have examined the effects of sexual rehabilitation therapy on the sexual functioning of gynecological cancer survivors and provide relevant research and clinical recommendations. We also discuss reasons to involve patients' sexual partners in psychosocial oncology research, given the complex interplay between patients' and partners' psychosexual issues.     

Sexual coercion in lesbian and gay relationships: A review and critique

Sexual coercion, or pressure to engage in unwanted sexual behavior, has been a popular research topic for social scientists interested in heterosexual relationships. Only recently have researchers turned their attention to lesbian and gay couples. Several research studies are reviewed to assess rates, causes, and effects of sexual coercion in lesbian and gay relationships. Several methodological issues that limit usefulness of findings on homosexual sexual coercion are discussed as well as reasons why social scientists have been reluctant to investigate sexual coercion in lesbian and gay relationships.     

Public Reason, Religious Restraint and Respect

In recent years liberals have had much to say about the kinds of reasons that citizens should offer one another when they engage in public political debates about existing or proposed laws. One of the more notable claims that has been made by a number of prominent liberals is that citizens should not rely on religious reasons alone when persuading one another to support or oppose a given law or policy. Unsurprisingly, this claim is rejected by many religious citizens, including those who are also committed to liberalism. In this paper I revisit that debate and ask whether liberal citizens have a moral obligation not to explain their support for existing or proposed laws on the basis of religious reasons alone. I suggest that for most (ordinary) citizens no such obligation exists and that individuals are entitled to explain their support for a specific law and to persuade others of the merits of that law on the basis of religious reasons alone (though there may be sound prudential reasons for not doing so). My argument is grounded in the claim that in most instances advocating laws on the basis of religious reasons alone is consistent with treating citizens with equal respect. However, I acknowledge an exception to that claim is to be found when using religious reasons to justify a law also implies that the state endorses those reasons. For this reason I argue that there is a moral obligation for some (publicly influential) citizens, and especially those who hold public office, to refrain from explaining their support for existing or proposed laws on the basis of religious reasons. I conclude by suggesting that this understanding of the role of religion in public political discourse and the obligations of liberal citizens is a better reflection of our experience of liberal citizenship than that given in some well-known accounts of liberalism.